Chapter 18: Naturopathic Physicians

Billing & Payment Policies for Healthcare Services provided to Injured Workers and Crime Victims

 

 

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Effective July 1, 2011

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(Republished February 1, 2012)

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Table of contents

Definitions

Payment policies:
Naturopathic office visits

More info:
Related topics


Definitions

Established patient:

One who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.

L&I uses the CPT® definition for established patients.  Refer to a CPT® book for complete code descriptions, definitions, and guidelines.

New patient:

One who hasn’t received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.

L&I uses the CPT® definitions for new patients.  Refer to a CPT® book for complete code descriptions, definitions, and guidelines.

Payment policy: Naturopathic office visits

Who must perform these services to qualify for payment

Naturopathic physicians must perform these services to qualify for payment.

Services that can be billed

For initial office visits, these local billing codes can be billed:

  • 2130A (Routine examination, history, and/or treatment – routine procedure – and submission of a report), which has a maximum fee of $116.21,
  • 2131A (Extended office visit including treatment – report required), which has a maximum fee of $168.23, and
  • 2132A (Comprehensive office visit including treatment – report required in addition to the report of accident), which has a maximum fee of $257.88.

Note: To determine whether or not a visit is an “initial” office visit, see the definition of new patient in “Definitions” at the beginning of this chapter.

For follow up office visits, these local billing codes can be billed:

  • 2133A (Routine office visit including evaluation and/or treatment), which has a maximum fee of $68.07, and
  • 2134A (Extended office visit including treatment – report required), which has a maximum fee of $140.01.

Note: To determine whether or not a visit is a “follow up” office visit, see the definition of established patient in “Definitions” at the beginning of this chapter.

Services that aren't covered

The insurer won’t pay naturopathic physicians for services that aren’t specifically allowed, including consultations.

Link: For details about payment criteria and documentation requirements for case management services, see the payment policies for “Case management services” in the Evaluation and Management chapter.  

Requirements for billing

When billing for services, naturopathic physicians should use:

  • The local codes listed in this payment policy (under “Services that can be billed”) to bill for office visit services,
  • CPT® codes 99367 and 99441-99444 to bill case management services, and
  • The appropriate HCPCS codes to bill for miscellaneous materials and supplies.

Link: For details about payment criteria and documentation requirements for case management services, see the payment policies for “Case management services” in the Evaluation and Management chapter.

If you’re looking for more information about… Then go here:
Administrative rules for radiology, radiation therapy,
nuclear medicine, pathology, hospital, chiropractic,
physical therapy, drugless therapeutics, and
nursing — drugless therapeutics, etc.
Washington Administrative Code (WAC) 296-23-205:
http://apps.leg.wa.gov/wac/default.aspx?cite=296-23-205
WAC 296-23-215:
http://apps.leg.wa.gov/wac/default.aspx?cite=296-23-215
Becoming an L&I provider L&I’s website:
www.Lni.wa.gov/ClaimsIns/Providers/Becoming/default.asp
Billing instructions and forms Chapter 1:
Introduction
Fee schedules for all healthcare services L&I’s website:
http://feeschedules.Lni.wa.gov

Need more help?  Call L&I’s Provider Hotline at 1-800-848-0811.


 

CPT® codes and descriptions only are © 2010 American Medical Association

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